The impact of integrated care in community-based substance use treatment in Brazil: A longitudinal study.

Integrated care (outpatient-inpatient) plays a vital function in community care for people with drug use problems. Its recent and innovative treatment model is representing a challenge for the deinstitutionalisation process. The purpose of this study was to assess the impact of integrated care using biopsychosocial indicators. We conducted a prospective longitudinal study with 122 clients from the baseline undergoing integrated care of two Psychosocial Care Centers for Alcohol and Other Drugs in São Paulo, Brazil, with three months follow-up (February 2019-January 2020). To assess the biopsychosocial indicators of the impact, we used the Substance Addiction Consequences (SAC), WHOQOL-BREF quality of life scales and the psychosocial rehabilitation axes (housing, work/income, and support network). We conducted a longitudinal analysis with linear mixed-effects models. The integrated care impacted the reduction in the days of substance use and increase of abstinence with a significant difference for cannabis (p < 0.001) and crack (p = 0.021). It reduced the substance use harms in all SAC scale dimensions (p < 0.001). Quality of life increased and remained mainly associated with the psychological size (p < 0.001). All psychosocial rehabilitation axes improved with a difference for income (p = 0.025). The increase in people's participation in treatment was relevant. The integrated care of Brazilian services has a positive impact on reducing substance use days and harms associated, improves the quality of life and contributes to the psychosocial rehabilitation of clients. Should be taken efforts to maintain long-term results.

Cultural adaptation and Rasch psychometrics of the Substance Addiction Consequences scale.

This study aims to adapt and evaluate the validity of the Substance Addiction Consequences scale for the Brazilian community-based addiction setting. This is a psychometric study, conducted in two stages: (1) cultural adaptation and (2) validation using the psychometric Rasch model. The Substance Addiction Consequences derived from the Nursing Outcome Classification comprises 16 items and four domains in the original instrument. We applied the original scale with 200 outpatients at two Psychosocial Care Centers for Alcohol and Drugs in São Paulo, Brazil. The four subscales are suitable for the Rasch model. In 13 of the 16 items, infits and outfits are between 0.5 and 1.5, corresponding to the model's optimal parameters. In addition, we removed one item that distorted the measurement. The psychometrics suggested that the SAC scale is valid with its 15 items and four domains. Therefore, it can be considered appropriate to use in the Brazilian community-based addiction setting.